In young adults, the disease often results in fever, sore throat, enlarged lymph nodes in the neck, and tiredness. Classic physical findings include fever, splenomegaly, pharyngitis, and lymphadenopathy. Feb 27, 2015 diagnosis of infectious mononucleosis because of primary ebv infection. Ebv is found worldwide and infects about 90% of people by adulthood, although most people never show symptoms centers for disease control and prevention cdc, 2014. Large studies of infectious mononucleosis are now decades old, but traditionally, the peak incidence of infection has been described in the 15 to 24year age range. Wait to return to sports and some other activities. The disease is spread through saliva and can cause fever, sore throat, and swollen lymph nodes. Mononucleosis syndromes infectious disease advisor. Sore throat, perhaps misdiagnosed as strep throat, that doesnt get better after treatment with antibiotics. The patient was also instructed not to drink alcohol and to use good hygiene practices and avoid sharing food or beverages.
However, posterior cervical or generalized adenopathy or hepatosplenomegaly suggests. Some data derived in the united kingdom suggest that infectious mononucleosis im cases may be occurring later in life with increasing severity, requiring hospitalization. Infectious mononucleosis page 1 of 2 communicable diseases factsheet infectious mononucleosis mostly affects teenagers and young adults. Infectious mononucleosis msd manual professional edition. High wbc, over 20% atypical reactive lymphocytes also known as downey cells. In addition to a complete medical history and physical examination of your child, a diagnosis of mononucleosis is usually based on reported symptoms. What test is the best for diagnosing infectious mononucleosis. Mono is usually a mild illness that goes away without treatment after several weeks. Differential diagnoses infectious mononucleosis im. Symptoms may develop slowly and may not all occur at.
Pathophysiology and clinical presentation correct diagnosis infectious mononucleosis is a highly contagious viral disease caused by the epsteinbarr virus ebv. Infectious mononucleosis, or mono, refers to a group of symptoms usually caused by the epsteinbarr virus ebv. Epsteinbarr virus encephalomyelitis diagnosed by polymerase chain. Infectious mononucleosis diagnosed by downey cells. Infectious mononucleosis is a acute infectious disease, caused by epsteinbarr virus evb that belongs to the herpesviridae. Mononucleosis, also known as mono, is an infectious disease that is usually caused by the epsteinbarr virus a herpes virus. Typical symptoms of infectious mononucleosis usually appear four to six weeks after you get infected with ebv.
There is no specific treatment for infectious mononucleosis. It is possible for the monospot test to come back negative early in the course of the infections false negative. Objective after presenting a case of severe infectious mononucleosis, the spectrum of disease is given. Mononucleosis mono is an infectious disease caused most often by the. Diagnosis of infectious mononucleosis by currently available testing remains somewhat problematic, especially early in the course of the illness. Infectious mononucleosis mono is an illness caused by several viral agents, most commonly the epsteinbarr virus ebv. Many people who get mono do not even know they have it. Diagnostic evaluation of mononucleosislike illnesses american. Infectious mononucleosis im, mono, also known as glandular fever, is an infection usually caused by the epsteinbarr virus ebv. At least one out of four teenagers and young adults who get infected. The differential diagnosis for suspected infectious mononucleosis is summarized in table 1. It is common among teenagers and young adults, especially college students. Typical symptoms of infectious mononucleosis usually appear 46 weeks after you get infected with ebv. Infectious mononucleosis mono is often called the kissing disease.
A heterophile antibody test for epsteinbarr virusinduced infectious mononucleosis is negative. Infectious mononucleosis is a clinical diagnosis, caused by epsteinbarr virus in 90% of cases, although in some patients pregnancy, high risk hiv population further investigations are warranted. Diagnosis of infectious mononucleosis to the editor. Ebv is in the herpes virus family, and is also known as human herpes virus type 4. The diagnosis infectious mononucleosis is primarily used when the syndrome is caused by ebv. Infectious mononucleosis mono is an infection that causes sore throat, fever, swollen glands, and tiredness or fatigue. Exudative pharyngitis, anterior cervical lymphadenopathy, and fever may be clinically indistinguishable from those caused by group a betahemolytic streptococci. Infectious mononucleosis im is a common childhoodadolescent illness. Jan 18, 2020 however, if dnabased investigations are not available, then it might be necessary to rely on the more tried and tested traditional method. Initial testing with a cbclooking for atypical lymphocytes which after several days replace the early granulocytic response and a heterophile antibody titeris a reasonable strategy.
Jul 01, 2001 prompt communication between the hematology laboratory and the attending physicians resulted in the diagnosis of atypical infectious mononucleosis for 17 patients for whom the diagnosis of infectious mononucleosis was not suspected. Diagnosis of infectious mononucleosis because of primary ebv infection. We believe that simply doing a full blood count with a manual differential is a rapid test that, as was true in 1923, can be a useful way of establishing a diagnosis of infectious mononucleosis. Illness usually lasts between one week and several weeks. Pathophysiology and clinical presentation correct diagnosis. Diagnosis of atypical cases of infectious mononucleosis. He or she will look for signs such as swollen lymph nodes, tonsils, liver or spleen, and consider how these signs relate to the symptoms you describe. It is mostly common among the teenagers and young people. A blood test can confirm the diagnosis in a patient who is suspected to have infectious mononucleosis. Mononucleosis is not considered a serious illness, but its symptoms may be severe enough to prevent a person from engaging in normal activities for several weeks. Rtpcr and measurement of ebvvl may provide useful tools for the early diagnosis of infectious mononucleosis in cases with inconclusive serological results vouloumanou et al. A typical clinical picture in an adolescent or young adult with a positive heterophile test is usually sufficient to make the diagnosis of infectious. Nov 26, 2012 because leukocytosis is the rule in infectious mononucleosis, the presence of a normal or decreased wbc count should suggest an alternative diagnosis.
Epsteinbarr virus ebv is the most common cause of infectious mononucleosis, but other viruses can also cause this disease. Most people are infected by the virus as children, when the disease produces few or no symptoms. Oct 17, 2017 mononucleosis, or mono, has a wide range of symptoms, which can make it hard to diagnose. More severe cases and unusual complications occasionally occur.
Infectious mononucleosis symptoms, diagnosis and treatment. Jun 21, 2015 infectious mononucleosis 4 to 7 week incubation acute selflimiting infection of the re system enlarged lymph nodes in the neck. While i have no arguments with this general concept, i would like to answer certain criticisms raised by dr. Infectious mononucleosis may begin slowly with fatigue, a general ill feeling, headache, and sore throat. Later, in the 1920s it was found to be associated with a mono. Mononucleosis university health services university of california. Mononucleosis is sometimes called the kissing disease, but kissing isnt the only way you can get it. Mononucleosis tests including the monospot test and ebv antibody test are blood tests. Your doctor may suspect mononucleosis based on your signs and symptoms, how long theyve lasted and a physical examination. Lymphocytosis accompanies infectious mononucleosis, increases during the first few weeks of illness, and then gradually returns to normal. Infectious mononucleosis adolescent medicine jama jama. Differential diagnosis of infectious mononucleosis. Youll need to see your doctor to find out if you have. Mononucleosis, or mono, has a wide range of symptoms, which can make it hard to diagnose.
Complete blood count cbc may be done to help confirm the diagnosis of mono and rule out other infections or complications of mono. Returning to your usual schedule too soon can increase the risk of a relapse. The kissing disease is a contagious sickness caused by the epstein barr virus, which is transmitted in saliva. Lymphocyte subsets from whole blood were examined in 25 acute infectious mononucleosis patients with facsort flow cytometer. Symptoms may develop slowly and may not all occur at the same time. Sore throat, fever, rash malaise, lethargy, extreme tiredness liver and spleen involvement and enlargement hematology. F is a generally healthy 19yearold college student. Infectious mononucleosis is transmitted by exposure to saliva, so it can be spread by kissing, by sharing glasses or cutlery, and by droplets spread by coughing. Infectious mononucleosis, also called mono, is a contagious disease. Infectious mononucleosis is a clinical diagnosis, caused by epsteinbarr virus in 90% of cases, although in some patients pregnancy, high risk. Discussion the majority of cases of infectious mononucleosis are self limiting and require. Read about infectious mononucleosis mono treatment, symptoms, signs, risks, and diagnosis. Mononucleosis mono is an infectious disease caused most often by the epsteinbarr virus ebv. The virus that causes mono is transmitted through saliva, so you can get it through kissing, but you can also be exposed through a cough or sneeze, or by sharing a glass or food utensils with someone who has mono.
Current diagnosis and management of infectious mononucleosis. It can be caused by a number of pathogens, but this chapter considers it as disease resulting from primary epsteinbarr virus ebv infection and is focused on the immunocompetent host. Pediatric infectious mononucleosis childrens national. Lab logic diagnosis of infectious mononucleosis by cathy r. Your doctor can advise on treatment for symptoms such as fever and sore throat. It typically occurs in teenagers, but you can get it at any age. John dirckx called attention to the need for observance of strict criteria for the diagnosis of infectious mononucleosis. Lab logic the diagnosis of infectious mononucleosis, instructed to rest as much as possible, and to avoid contact sports for 1 month.
Infectious mononucleosis approach bmj best practice. Patients presenting with fever and swollen lymph glands with complaints of sore throat and recent fatigue provide rationale for this differential diagnosis. Mono is an extremely common illness in children and young adults, with many cases being mild and resolving promptly without the patient feeling sick enough to. Infectious mononucleosis mostly affects teenagers and young. It is most commonly caused by the epsteinbarr virus ebv. Always consult your childs physician for a diagnosis. Infectious mononucleosis im is characterized by a triad of fever. Typical features of infectious mononucleo sis include fever, pharyngitis, adenopathy, malaise, and an atypical lymphocytosis. Most signs and symptoms of mononucleosis ease within a few weeks, but it may be two to three months before you feel completely normal. Im typically manifests in adolescents and young adults as a febrile illness with sore throat and enlarged lymph nodes. Infectious mononucleosisaka mono what is infectious mononucleosis. Like ebv, it belongs to the herpes virus family, usually causes an asymptomatic infection early in life in most individuals, and then lies dormant and remains within the host for life. History and pathophysiology infectious mononucleosis was first described in the 19th century as drusenfieber, or glandular fever, owing to its clinical presentation of fever with lymphadenopathy and splenomegaly. Infectious mononucleosis is a clinical entity characterized by sore throat, cervical lymph node enlargement, fatigue and fever.
Positive heterophile antibody test and serologic test for antibodies against ebv are usually diagnostic. Infectious mononucleosis should be suspected in patients with typical symptoms and signs. Characterized by the classic triad of fever, pharyngitis, and lymphadenopathy, along with atypical lymphocytosis. The symptoms of the mononucleosis may resemble other medical conditions. Learn from the experts at webmd how to spot the signs of mono and get the right treatment. There is a practical way and a precise way to diagnose infectious mononucleosis because of primary ebv infection. The cause of infectious mononucleosis cannot be determined on clinical grounds alone. Cmv mononucleosis is estimated to comprise 7% of all infectious mononucleosis syndromes.
As a consequence, no additional tests and no therapy were prescribed. Common questions about infectious mononucleosis jason womack, md, and marissa jimenez. Infectious mononucleosis is a highly contagious viral disease caused by the epsteinbarr virus ebv. The more rest you get, the sooner you should recover. Learn more about the symptoms of coronavirus covid19, how you can protect your family, and how nationwide childrens hospital is preparing. If acute hiv infection is suspected, a quantitative polymerase chain reaction test should be performed.
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